Provider Demographics
NPI:1720741747
Name:DUDLA, COURTNEY SUSAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:SUSAN
Last Name:DUDLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-783-3110
Mailing Address - Fax:518-609-3849
Practice Address - Street 1:711 TROY SCHENECTADY RD STE 201
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2461
Practice Address - Country:US
Practice Address - Phone:518-783-3110
Practice Address - Fax:518-609-3849
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY067925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist